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� <br /> FOR C1TY USE ONLY <br /> ��=,,��E-7�r� Clty of Orono Date Received: Permit# <br /> ; P.O.Box 66 / <br /> � �� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed� p/' �(���� <br /> ` \E " , � Crystal Bay,MN 55323 �� <br /> ` ��� (952)249-4600/Fax(952)249-4616 Approved By(If Required): <br /> CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT <br /> (*Note:Some permiu may require approval by the Buildine Official andlor Public Works Department*) <br /> (ALL PERMITS- Ma��be subiect to further revien and mav not be issued when the application is received) <br /> GENERAL 1NFORMATION <br /> 1. You may apply for utility permits by mail or in person at the City offices. <br /> 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will <br /> be sent by return mail within 2 business days. <br /> 3. Permits are not valid unril you receive a permit card. <br /> 4. Work must not begin unless the permit card is available on the job site. <br /> 5. Utility connection permits may be issued to licensed contractors only. <br /> 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. <br /> DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express <br /> approval of the Public Works Department. Issuance of a permit does not grant this approval. <br /> 7. All work must be done in accordance with State Code requirements. <br /> 8. All work must be inspected before it is covered. Ca11 (952)249-4600,24+hour notice required. <br /> TYPE OF PERMIT <br /> (Check All That A 1 ) <br /> �Residential (May Require Approval) ❑ Commercial(Approval Required) <br /> ❑New Connection ❑ Additional Connection �Re-Connection ❑Repairs ❑Disconnect <br /> ❑ Water Availability Connection For Future Hook-Up to Water <br /> Job Site/Owner Information: <br /> Site Address: �y/Q G��y QG9e� <br /> Owner: ��N�-Wa� �Gp�s, Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor Information: <br /> Contractor: D,S.l�, ��Rl/�T3iYjo I�XC,Contact Person: �,�'.� �d�'e2'''�� <br /> Address: �/�.�0�?S�I7� � State License#: <br /> City: ��L•S Zip: S�� Expiration Date: <br /> Phone: �as�- ��Q•/3 S�f Alternate Phone: <br />